The words ‘ childbirth interventions’ started to be used by the Natural Birth Movement and The Midwifery Movement in the mid1970s. What words were used before then? Medical assessments, monitoring, procedures (AMPs), ‘standards of care’, ‘guidelines of practice’ or ‘evidence based maternity care’ were the way people explained the medical care around pregnancy and childbirth. From the mid1970s everything got lumped into the one word (childbirth) ‘interventions’ and that one word then became part of the phrase … ‘cascade of interventions’. What exactly does the word ‘intervention’ mean? And why is there a belief there’s a ‘cascade of childbirth interventions?’
The implication attached to childbirth ‘interventions’
The way the word ‘intervention’ is used in association with childbirth since the mid1970s is clear. The message is simple:
- Interventions are imposed on women
- Interventions are mostly unnecessary
- One intervention will lead to another and another … cascade of interventions
- Women have no control.
The underlying philosophy behind this interpretation of childbirth ‘intervention’ is also clear. The implication is that birth is SO NATURAL that nothing should be done during that process unless absolutely medically necessary.
In fact in New Zealand where our Trust exists, the College of Midwives core philosophy specifically states: ‘Pregnancy and birth are normal life events that rarely require medical care?’
Are these messages true?
Birth is natural and normal but …
Without a doubt pregnancy and birth are normal and natural life events. But what do the words ‘normal’ and ‘natural’ mean or suggest?
Within the Natural Birth and Midwifery Movement these words imply that ‘natural and normal’ pregnancy and birth are safe, easy to manage and have good outcomes and rarely need medical care. Therefore the words ‘normal’ and ‘natural’ have been coopted toward a specific interpretation that is narrow. This causes HUGE confusion and conflict.
To understand the words ‘normal’ and ‘natural’ let’s consider taking away all medical care.
Millions of women globally live in communities where there is no medical care. Do they share the same belief that the Natural Birth and Midwifery Movement does? No. When there is no medical care, pregnant women know that the words ‘normal’ and ‘natural’ means that anything that happens is both natural and normal whether pleasant or unpleasant.
Therefore we have a problem and the problem is leading pregnant women to confusion. Let’s give some examples of what is ‘normal’ and ‘natural’ in both pregnancy and birth that may cause problems. In traditional communities there would be no AMPs (assessments, monitoring or procedures … pre1970s) or Interventions (cascade of interventions … post1970s).
These are all ‘normal’ and ‘natural’
Because the below are all normal and natural, in modern societies there will be some form of AMPs/childbirth interventions.
- Any woman (and many do) can bring health issues into pregnancy that either impact or not the rest of pregnancy and birth.
- Any woman (and many do) can develop health issues in pregnancy that either impact or not the rest of pregnancy and birth.
- Any woman (and many do) can develop health issues in birth that either impact or not the birth.
- Any woman (and some do) can be absolutely healthy yet her baby can have health issues that either impacts or not the rest of pregnancy and birth.
- Any woman (and some do) can be healthy and have an absolutely wonderful birth yet her baby can develop health issues during the birth that may or may not have a negative impact.
Pregnancy and birth are normal and natural life events that include both the good, bad, ugly, hard, easy, lovely, hated, joyful, sad.
How a word changes emotions
To understand AMPs or childbirth interventions, we need to understand their use in modern maternity care.
- They are used to assess whether there are problems
- They monitor either recognised problems or try to determine whether a problem is going to exist
- Procedures are done to reduce or prevent a problem from getting out of hand or as a ‘standard of care’.
Now use the word childbirth ‘interventions’ in the above sentences. See how your emotions change.
What if there’s a problem?
That is every family’s fear. ‘What if there’s a problem?’
In fact there is absolutely no correlation between risk factors:
- and the ability of the woman with health issues to cope well with the natural occurring pain of contractions or how easily she can get her baby out of her body.
- And there is no correlation between how a healthy woman copes with the natural occurring pain of contractions or whether her baby ends up with some sort of issue.
So how does any woman, her partner, her obstetrician or midwife determine whether she or her baby are healthy and well and therefore should have absolutely no ‘interventions’? We can’t.
And we live in modern countries where there is heaps of medical attention in our lives.
Would most modern women really not want their obstetrician or midwife to do some assessments, monitoring and procedures when necessary? Of course not. Modern families want to take advantage of modern medical care. We feel safer because of modern medical care.
What just happened?
Change words and this changes emotions
- Would most modern women really not want their obstetrician or midwife to do some assessments, monitoring and procedures (AMPs)? Does that sound so bad? Do you want to reject all AMPs?
- Would most modern women really not want their obstetrician or midwife to do interventions? How does that sound when we shift the word to ‘interventions’ rather than AMPs?
As soon as AMPs were replaced by Interventions then the whole childbirth conversation shifted and with it the huge rise of shame, blame, guilt, anger, disappointment.
AMPs and Childbirth Interventions
Here are some questions you must ask yourself:
- How comfortable are you with having any AMPs done to you?
- How comfortable are you not having any of them ever done to you?
Then rephrase those questions with the word ‘intervention’ instead of AMP? There’s a huge difference!
AMPs are definitely part of the modern medical maternity care that you will experience to some degree or not. AMPs are part of the ‘standards of care’.
Every modern pregnant woman seeing an obstetrician or midwife will experience these AMPs/interventions whether she wants them or not.
So how do you get around this and is there anything you can do that will allow you to work with the AMPs/Interventions if necessary even if you don’t want or like them or believe you need them?
Do Birth Plans avoid AMPs/childbirth interventions?
No. Too many Birth Plans fail too many women. There is no way to know what your birth will be like. You live in a modern world and maternity care is full of AMPs/interventions. Even if you have a home birth you will have some of them. In fact there is a long, long list of what natural birth and midwifery advocates consider to be childbirth birth interventions. Take a look at this article and here’s a list. RED = short list that is consider part of the ‘cascade of interventions’, BLUE = longer list that is considered to be part of the ‘cascade of interventions’.
- Being given an enema
- Being shaved
- Being left alone
- Only having one person with you
- Staying in bed
- Vaginal exams
- Not being able to eat or drink during birth
- Induction of labor
- Breaking the water
- Constant foetal monitoring
- Augmentation of labor
- Directed pushing
- Vacuum extraction
- medical pain relief … gas, medications, epidurals
- Not being asked permission
- Having someone do something to you in a rough or disrespectful manner
- Cutting the cord early
- Not letting your baby go to breast right away
- Removing your baby from the room
In other words, unless birth on your own you will experience some type of AMPs or childbirth interventions during your baby’s birth.
What Birthing Better families did and do?
Birthing Better Childbirth Preparation skills evolved in the 1970s from families who did not have ‘birth choices’ and could not make Birth Plans.
Birthing Better families wanted birth and birth coaching skills so we could ‘do’ something while the AMPs/Interventions were done. The skills worked brilliantly. When we told our Birth Story we noticed something amazing …We focused more on what we ‘did’ rather then what ‘happened’ to us.
We knew we were on to something. In every birth we birthed better because we had skills … we didn’t always have better births. In other words, we stopped focusing on the ‘standards of care’ that we might have and focused on using skills to work alongside with any type of health care part of our birthing experience.
However there was one very important thing we noticed. When we were skilled our birth professional was more relaxed and we had fewer AMPs/Interventions because we showed them by our behaviors that we were in control.
It’s not about childbirth interventions really. It’s about having a safe birth for yourself and baby AND having an empowered birth experience. Birthing Better Childbirth Preparation Online Courses are about having personal skills to work with your baby’s efforts to be born no matter what … including childbirth interventions.